A daily study of stressors, continuously measured glucose, and diabetes symptoms in latinos with type 2 diabetes.
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ABSTRACT:
SUBMITTER: Wagner J
PROVIDER: S-EPMC7710922 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionType 1 diabetes mellitus (T1DM) is associated with earlier onset of cardiovascular disease. Recent evidence has found hyperglycaemia appears to play a greater role in this association among T1DM compared to T2DM. This study investigates the relationship between glucose and QTc (a key cardiovascular measure) using data from continuous electrocardiogram (ECG) and glucose monitors.MethodsSeventeen adults with T1DM were recruited at a clinical facility in Ireland. A continuous glucose monitoring system was fitted to each participant that measured glucose every 5 min for 7 days. The participants simultaneously wore a vest with sensors to measure 12-lead ECG data every 10 min for 7 days. Area under the glucose curve (AUC), proportion of time spent in hypoglycaemia and hyperglycaemia, and mean daily absolute deviation of glucose were calculated. Mixed effects ANOVA and functional regression models were fitted to the data to investigate the aggregate and time-dependent association between glucose and QTc.ResultsAll participants were male with an average age of 52.5 (SD 3.8) years. Those with neuropathy had a significantly higher mean QTc compared to their counterparts. Mean QTc was significantly longer during hyperglycaemia. There was a significant positive association between QTc and time spent in hyperglycaemia. A negative association was found between QTc and time spent in hypoglycaemia. A functional model suggested a positive relationship between glucose and QTc at several times during the 7-day follow-up.ConclusionThis study used sensor technology to investigate, with high granularity, the temporal relationship between glucose and ECG data over one week. QTc was found to be longer on average during hyperglycaemia.
| S-EPMC8279601 | biostudies-literature
Project description:OBJECTIVE:To examine the influence of daily sleep quality in patients with Type 1 diabetes (T1D) on that of their spouses and to investigate the influence of couples' sleep quality on patients' diabetes-specific stressors and couples' general stressors the following day. METHODS:199 patients with Type 1 diabetes (Mage = 46.82) and their spouses (Mage = 46.41) completed a 14-day diary where they reported on their own sleep quality, and the presence of general stressors. Patients reported the presence of diabetes-specific stressors. Multilevel modeling examined the effects of daily variability in (within-person effects) and average levels of (between-person effects) sleep quality on the number of next-day diabetes-specific stressors (controlling for prior day stressors). Furthermore, the actor-partner interdependence model was used to examine the effect of sleep quality on general stressors. RESULTS:Greater patients' daily sleep quality was related to their spouses' greater sleep quality. Increases in the patients' own daily- and average sleep quality were uniquely associated with fewer next day diabetes-specific stressors. Better own daily- and average sleep quality were associated with fewer general stressors for both partners. Spouses' increased daily sleep quality was associated with fewer general stressors of patients. CONCLUSIONS:The results support that sleep quality is a dyadic phenomenon among couples and suggest that better sleep quality may buffer diabetes specific and general stress in couples coping with T1D. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
| S-EPMC6309199 | biostudies-literature
Project description:We examined how dietary and physical activity behaviors influence fluctuations in blood glucose levels over a seven-day period in people at high risk for diabetes. Twenty-eight participants underwent a mixed meal tolerance test to assess glucose homeostasis at baseline. Subsequently, they wore an accelerometer to assess movement behaviors, recorded their dietary intakes through a mobile phone application, and wore a flash glucose monitoring device that measured glucose levels every 15 min for seven days. Generalized estimating equation models were used to assess the associations of metabolic and lifestyle risk factors with glycemic variability. Higher BMI, amount of body fat, and selected markers of hyperglycemia and insulin resistance from the meal tolerance test were associated with higher mean glucose levels during the seven days. Moderate- to vigorous-intensity physical activity and polyunsaturated fat intake were independently associated with less variation in glucose levels (CV%). Higher protein and polyunsaturated fatty acid intakes were associated with more time-in-range. In contrast, higher carbohydrate intake was associated with less time-in-range. Our findings suggest that dietary composition (a higher intake of polyunsaturated fat and protein and lower intake of carbohydrates) and moderate-to-vigorous physical activity may reduce fluctuations in glucose levels in persons at high risk of diabetes.
| S-EPMC8781180 | biostudies-literature
Project description:Objective: In contrast with exercise, or structured physical activity (PA), glycemic disturbances due to daily unstructured PA in patients with type 1 diabetes (T1D) is largely underresearched, with limited information on treatment recommendations. We present results from retrospective analysis of data collected under patients' free-living conditions that illuminate the association between PA, as measured by an off-the-shelf activity tracker, and postprandial blood glucose control. Research Design and Methods: Data from 37 patients with T1D during two clinical studies with identical data collection protocols were analyzed retrospectively: 4 weeks of continuous glucose monitoring, carbohydrate intake, insulin injections, and PA (assessed through wearable activity tracker) were collected in free-living conditions. Five-hour glucose area under curves (GAUCs) following the last-bolused meal of every day were computed to assess postprandial glucose excursions, and their relation with corresponding antecedent PA was analyzed using linear mixed-effects regression models, accounting for meal, insulin, and current glycemic state. Results: Datasets yielded 845 days of data from 37 subjects (22.8 ± 11.6 days/subject); postmeal GAUC was negatively associated with total daily PA measured by step count (P = 0.025), and total time spent performing higher than light-intensity PA (P = 0.042). Patients with higher median total daily PA exhibited lower average postprandial GAUC (P < 0.01). Additional analyses indicated that daily PA likely presents an immediate and delayed impact on glucose control. Conclusion: Daily PA assessed by commonly available sensors is significantly associated with glycemic exposure after an evening meal, indicating that quantitative assessment of PA may be useful in mealtime treatment decisions.
| S-EPMC7591370 | biostudies-literature
Project description:Continuous glucose monitors (CGM) record interstitial glucose levels 'continuously', producing a sequence of measurements for each participant (e.g. the average glucose level every 5 min over several days, both day and night). To analyse these data, researchers tend to derive summary variables such as the area under the curve (AUC), to then use in subsequent analyses. To date, a lack of consistency and transparency of precise definitions used for these summary variables has hindered interpretation, replication and comparison of results across studies. We present GLU, an open-source software package for deriving a consistent set of summary variables from CGM data. GLU performs quality control of each CGM sample (e.g. addressing missing data), derives a diverse set of summary variables (e.g. AUC and proportion of time spent in hypo-, normo- and hyper- glycaemic levels) covering six broad domains, and outputs these (with quality control information) to the user. GLU is implemented in R and is available on GitHub at https://github.com/MRCIEU/GLU. Git tag v0.2 corresponds to the version presented here.
| S-EPMC7394960 | biostudies-literature
Project description:BackgroundCardiovascular disease (CVD) risk factor control is a cornerstone of diabetes mellitus management. Little is known about relationships of objectively measured sedentary time and physical activity with major CVD risk factor control in individuals with diabetes mellitus. We examined associations of objectively measured sedentary time and moderate-to-vigorous physical activity with reaching major CVD risk factor control goals among US Hispanic/Latino adults with diabetes mellitus.Methods and resultsThis cross-sectional analysis included 1699 participants with diabetes mellitus from the Hispanic Community Health Study/Study of Latinos (2008-2011). Logistic regression models were used to estimate the odds ratios (ORs) of meeting the following 5 major CVD risk factor control goals: hemoglobin A1c <7.0%; systolic/diastolic blood pressure <140/80 mm Hg; triglycerides <150 mg/dL; low-density lipoprotein cholesterol <100 mg/dL; and high-density lipoprotein cholesterol >40/50 mg/dL for men/women. After adjustment for covariates including moderate-to-vigorous physical activity, less sedentary time was associated with increased odds of reaching hemoglobin A1c (OR=1.76 [95% CI: 1.10, 2.82]) and triglyceride control goals (OR=2.16 [1.36, 3.46]), and reaching ≥3 CVD risk factor control goals (OR=2.08 [1.34, 3.23]) (all ORs for comparisons of extreme tertiles of sedentary time). Moderate-to-vigorous physical activity was not associated with reaching any CVD risk factor control goals. Substituting 60-min/day of sedentary time with light-intensity physical activity was associated with increased odds of reaching hemoglobin A1c (OR=1.18 [1.04, 1.35]), high-density lipoprotein cholesterol (OR=1.17 [1.04, 1.32]), and triglyceride (OR=1.20 [1.05, 1.36]) control goals.ConclusionsAmong US Hispanic/Latino adults with diabetes mellitus, less sedentary time, but not moderate-to-vigorous physical activity, was associated with improved CVD risk factor control, specifically in reaching hemoglobin A1c and triglyceride control goals.
| S-EPMC5669141 | biostudies-literature
Project description:Introduction: Acupuncture is a widely used technique for the treatment of diabetes in Asian countries. Nevertheless, there are few studies with appropriate methodological rigor evaluating its effectiveness and promoting a standardized procedure in the Western World. Objectives: Evaluate the short-term effect of acupuncture in the treatment of type 2 diabetes mellitus (DM2) using continuous glucose monitoring (CGM). Methods: In a randomized controlled prospective open-label study, we assigned 20 insulin-independent DM2 patients to undergo acupuncture (group 1) or control group (group 2). Participants underwent CGM for 14 days. In group 1, all patients were submitted to acupuncture 4, 8, and 12 days after installation of the monitoring system. Diabetes-specific treatment points were used in all patients (bladder 38, large intestine 4, kidney 24, stomach 36, and spleen 9). This study was approved by the ethics committee (CAAE-60576616.6.0000.5572). Results: There were no statistically significant differences in the baseline characteristics. In group 1, mean glucose level obtained through 14 days monitoring after acupuncture treatment was 143 ± 28.8 mg/dL, whereas in group 2, who did not receive acupuncture, the mean level was 165.8 ± 30.2 mg/dL (P = 0.015). Conclusion: In this randomized pilot study, there was an improvement in global glycemic control during the 14-day monitoring in the acupuncture group. Further studies with larger cohorts over a more extended period of time are needed. Clinical Trials: RBR-3m45y3.
| S-EPMC7894033 | biostudies-literature
Project description:Despite advances in diabetes management, the reporting and self-monitoring of blood glucose (SMBG) remains fundamental. While previous work has established that the misreporting of SMBG to family and medical professionals is surprisingly common, the motivations behind this behaviour have never been examined. We aimed to investigate the motivations behind misreporting of SMBG in adolescents with type 1 diabetes (T1DM).Fifteen semi-structured interviews were conducted with adolescents (aged 12-19 inclusive) with T1DM recruited through diabetes clinics across the Otago/Southland region of New Zealand from November 2015 to January 2016. These were transcribed and content analysis performed to identify themes and subthemes in misreporting behaviour.The mean age of participants was 15.7 years, 60 % were male, with 67 % using multiple daily insulin injections, and 33 % on insulin pumps. Their median HbA1c was 84 mmol/mol, range 52-130. Misreporting behaviour was described for both electronic pump records and written logbooks, as well as verbally. Multiple motivations for misreporting were given, spanning three major themes: Achieving potential benefits; the avoidance of negative consequences; and the avoidance of worry/concern (in self or in others). The main suggestion of participants to reduce misreporting behaviour was to reduce the negative reactions of others to suboptimal blood glucose readings.Electronic, written, and verbal SMBG misreporting remains common. This study provides deeper insight into the motivations leading to this behaviour in adolescents, suggesting that further understanding and attention to this aspect of adherence may lead to improvements not only in glycaemic control and safety, but also to the psychological wellbeing of those with T1DM.
| S-EPMC4893214 | biostudies-other
Project description:IntroductionDiabetic nephropathy remains a highly prevalent microvascular complication in individuals with type 2 diabetes mellitus (T2DM). Hispanic individuals are at increased risk of metabolic and cardiovascular complications compared with non-Hispanic white individuals. We described the long-term kidney outcomes using a culturally based approach to diabetes management in Hispanic patients implemented by the Joslin Diabetes Center's Latino Diabetes Initiative.MethodsOur retrospective study included 594 Hispanic patients evaluated at the Joslin Diabetes Center from July 2002 to July 2015. Demographic and clinical data were collected from the outpatient visits.ResultsUncontrolled high blood pressure (hazard ratio [HR]: 1.72; 95% confidence interval [CI]:1.18-2.51; P = 0.005), overweight (HR: 2.68; 95% CI: 1.13-6.38; P = 0.026), and longstanding T2DM duration (HR: 1.11; 95% CI: 1.08-1.14; P < 0.0001) at baseline were significantly associated with increased risk of chronic kidney disease (CKD). Although poor glycemic control (HR: 1.18; 95% CI: 1.099-1.258; P < 0.0001), systolic blood pressure (SBP) >140 (HR: 1.01; 95% CI: 1.006-1.02; P = 0.0002), and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use (HR: 1.53; 95% CI: 1.03-2.29; P = 0.04) were significantly associated with increased CKD incidence during follow-up. Interestingly, statin use was associated with lower CKD incidence during the follow-up (HR: 0.52; 95% CI: 0.42-0.65; P < 0.0001). The annual rate of renal function decline in our cohort was estimated to be -1.39 ml/min per 1.73 m2.ConclusionRenal function decline in Latinos is associated with expected but modifiable variables, such as uncontrolled diabetes, uncontrolled hypertension, and being overweight. However, the annual rate of renal function decline in our cohort was estimated to be comparatively higher than previous reports in Hispanic individuals without T2DM, and the general US population with T2DM, but lower than expected for this high-risk group. We highlight the importance of a culturally based patient-centered therapeutic approach to improve long-term outcomes in Hispanic patients at high risk of CKD.
| S-EPMC6732726 | biostudies-literature
Project description:ObjectiveTo evaluate glycemia and metrics of glucose variability in youth with type 1 diabetes, and to assess patterns of 24-h glucose variability according to pubertal status.Research design and methodsMetrics of glycemia, glucose variability, and glucose patterns were assessed by using 4 weeks of continuous glucose monitoring (CGM) data from 107 youth aged 8-17 years with type 1 diabetes for ≥1 year. Glucose values per hour were expressed as percentages relative to the mean glucose over 24 h for a 4-week period. Glucose data were compared on the basis of pubertal status-prepubertal (Tanner stage [T] 1), pubertal (T2-4), and postpubertal (T5)-and A1C categories (<7.5% [<58 mmol/mol], ≥7.5% [≥58 mmol/mol]).ResultsYouth (50% female, 95% white) had a mean ± SD age of 13.1 ± 2.6 years, diabetes duration of 6.3 ± 3.5 years, and A1C of 7.8 ± 0.8% (62 ± 9 mmol/mol); 88% were pump treated. Prepubertal youth had a higher mean glucose SD (86 ± 12 mg/dL [4.8 ± 0.7 mmol/L]; P = 0.01) and coefficient of variation (CV) (43 ± 5%; P = 0.06) than did pubertal (SD 79 ± 13 mg/dL [4.4 ± 0.7 mmol/L]; CV 41 ± 5%) and postpubertal (SD 77 ± 14 mg/dL [4.3 ± 0.8 mmol/L]; CV 40 ± 5%) youth. Over 24 h, prepubertal youth had the largest excursions from mean glucose and the highest CV across most hours compared with pubertal and postpubertal youth. Across all youth, CV was strongly correlated with the percentage of time with glucose <70 mg/dL (<3.9 mmol/L) (r = 0.79; P < 0.0001).ConclusionsPrepubertal youth had greater glucose variability independent of A1C than did pubertal and postpubertal youth. A1C alone does not capture the full range of glycemic parameters, highlighting the added insight of CGM in managing youth with type 1 diabetes.
| S-EPMC6925575 | biostudies-literature